Basic Information
| Provider Information | |||||||||
| NPI: | 1114574837 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BICKHAUS | ||||||||
| FirstName: | ALEXANDRA | ||||||||
| MiddleName: | N | ||||||||
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| Credential: | PCNP-AC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6950 MAGONA CT | ||||||||
| Address2: | |||||||||
| City: | MARYVILLE | ||||||||
| State: | IL | ||||||||
| PostalCode: | 620626883 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6184060350 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1 CHILDRENS PL | ||||||||
| Address2: | |||||||||
| City: | SAINT LOUIS | ||||||||
| State: | MO | ||||||||
| PostalCode: | 631101002 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3144546000 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 08/19/2019 | ||||||||
| LastUpdateDate: | 11/02/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 11/02/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0222X | 2019022492 | MO | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics, Critical Care |
No ID Information.